﻿CREATE TABLE [dbo].[CLM_835_2100_ClaimPayment]
(
[IDKey] [int] NOT NULL IDENTITY(1, 1),
[Header_LX01_ProviderSummaryProviderIDAssignedNumber] [nvarchar] (6) NULL,
[Payment_CLP01_PatientControlNubmer] [nvarchar] (38) NULL,
[Payment_CLP02_ClaimStatusCode] [nvarchar] (2) NULL,
[Payment_CLP03_TotalClaimChargeAmount] [money] NULL,
[Payment_CLP04_ClaimPaymentAmount] [money] NULL,
[Payment_CLP05_PatientResponsibilityAmount] [money] NULL,
[Payment_CLP06_ClaimFilingIndicatorCode] [nvarchar] (2) NULL,
[Payment_CLP07_PayerClaimControlNumber] [nvarchar] (30) NULL,
[Payment_CLP08_FacilityTypeCode] [nvarchar] (2) NULL,
[Payment_CLP09_ClaimFrequencyCode] [nvarchar] (2) NULL,
[Payment_CLP11_DRGCode] [nvarchar] (4) NULL,
[Payment_CLP12_DRGWeight] [nvarchar] (15) NULL,
[Payment_CLP13_DischargeFraction] [nvarchar] (10) NULL,
[ClaimAdj_CAS01_ClaimAdjustmentGroupCode] [nvarchar] (2) NULL,
[ClaimAdj_CAS02_AdjustmentReasonCode1] [nvarchar] (5) NULL,
[ClaimAdj_CAS03_AdjustmentAmount1] [money] NULL,
[ClaimAdj_CAS04_AdjustmentQuantity1] [int] NULL,
[ClaimAdj_CAS05_AdjustmentReasonCode2] [nvarchar] (5) NULL,
[ClaimAdj_CAS06_AdjustmentAmount2] [money] NULL,
[ClaimAdj_CAS07_AdjustmentQuantity2] [int] NULL,
[ClaimAdj_CAS08_AdjustmentReasonCode3] [nvarchar] (5) NULL,
[ClaimAdj_CAS09_AdjustmentAmount3] [money] NULL,
[ClaimAdj_CAS10_AdjustmentQuantity3] [int] NULL,
[ClaimAdj_CAS11_AdjustmentReasonCode4] [nvarchar] (5) NULL,
[ClaimAdj_CAS12_AdjustmentAmount4] [money] NULL,
[ClaimAdj_CAS13_AdjustmentQuantity4] [int] NULL,
[ClaimAdj_CAS14_AdjustmentReasonCode5] [nvarchar] (5) NULL,
[ClaimAdj_CAS15_AdjustmentAmount5] [money] NULL,
[ClaimAdj_CAS16_AdjustmentQuantity6] [int] NULL,
[ClaimAdj_CAS17_AdjustmentReasonCode6] [nvarchar] (5) NULL,
[ClaimAdj_CAS18_AdjustmentAmount6] [money] NULL,
[ClaimAdj_CAS19_AdjustmentQuantity6] [int] NULL,
[Patient_NM101_PatientEntityIDCode] [nvarchar] (3) NULL,
[Patient_NM102_PatientEntityTypeQualifier] [nvarchar] (1) NULL,
[Patient_NM103_PatientLastOrOrganizationName] [nvarchar] (35) NULL,
[Patient_NM104_PatientFirstName] [nvarchar] (25) NULL,
[Patient_NM105_PatientMiddleName] [nvarchar] (25) NULL,
[Patient_NM108_PatientIdentificationCodeQualifier] [nvarchar] (2) NULL,
[Patient_NM109_PatientID] [nvarchar] (80) NULL,
[BTSMessageID] [nvarchar] (100) NULL,
[BTSInterchangeID] [nvarchar] (100) NULL
) ON [PRIMARY]


